Winsor Care Services

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

People told us they felt staff knew them and their individual preferences well. They felt that care had been catered to their personal needs. Staff gave us examples of how they adapt their support for individuals. Staff told us they communicated well as a team and provided each other with handovers if another staff member was covering a care visit they could not attend. Some people and relatives were dissatisfied with poor continuity in their care, either by not being informed of changes or inconsistent carers which they could not form a relationship with. We were assured by the consultant of the provider that processes are being improved to ensure people and their relatives are better informed of changes. We saw minimal information sharing from the service to people. The provider had recently implemented a new face to face meeting with people to encourage involvement but this had not yet been embedded.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People who had consistent staff told us they felt staff knew them well. For example, one person told us, "[Staff member] knows exactly what I like and how I like things done. He even knows if I need milk or sugar and he brings it in with him without me having to ask". Those with less consistent staff did not feel staff knew them as well "I hope that they do but they are hardly with me long enough". This indicated that staff were not given enough personal detail about people in care plans for people to feel their care was centred to them individually. Relatives told us that they felt care was person centred for their loved ones. One relative told us, "My mum does not speak English but recently they have been sending carers that speak her languages". Relatives felt that people were able to exercise choice Another relative told us, "They know how she likes things to be done and if she asks them to something different say for example tie her hair up, they are happy to do it."

Staff told us they read care plans to understand individual needs and also get to know people for themselves. One staff member told us, "I read any assessments that have been completed if they are a new client. I also ask them how they want things to be done." Another staff member told us, "People with dementia all act differently. I check their care plan for person centred care and for any changes." Staff told us they support choice and control. One staff member told us, "It’s very important to work as a team, I also include my client as part of that team as they need to agree about what we are going to do" The registered manager told us that despite not all care plans being thoroughly updated and audited at this stage, they are focusing on the highest risks first. They assured us carers know people well and tend to be consistent which means person centred care is still maintained until the records are all fully updated.

We received mixed responses from people and relatives about the care delivery. Some people and relatives did not feel there was continuity of care. One relative told us, "They need to be consistent and send regular carers, my mum and other older people need consistency. " Another relative told us "Carers only find out the night before where they will be going." This meant people could not be informed about who to expect for their care provision. People told us they felt unhappy when there was a lack of continuity "I also do not feel comfortable bathing with a strange person every time." However not everybody experienced lack of continuity, with one person telling us "Yes, it is the same girls that visit me." and "Yes, I have the same people, they only change when they have days off." People told us they were called by the carers directly "When it has happened the carers have called me directly themselves." "[Carers] ring either me or my husband" when they were running late and sometimes did not receive a call "No, I am never contacted to tell me if they are running late" and "It is very rare that the office informs us of anything".

Staff told us they would ensure care was consistently provided by communicating with the office and other carers if they were too unwell to work. One staff member told us, "I am rarely off sick but I would let the office know as soon as I could so they can arrange cover. If I am well enough to speak with the other carers, I will find out who is covering for me and give them like a handover about my clients and update them with the details and needs and preferences." Staff said that people would be kept informed if there was a disruption to the continuity of their care "Some calls we have half an hour to complete. Sometimes the calls take longer. If the call takes longer regularly the manager will ring the next client. It does not happen very often for me, but I have a break in between calls so it does not normally affect my next call." The consultant employed by the provider told us that they are changing the way people are informed about their care and the office will always be the point of contact to keep people informed. The consultant told us, "Consistency in care is being monitored in real time by the office and any updates are now being picked up promptly."

Professionals told us that the service links up well with other professionals to join up care.

Continuity of care is addressed in carers tasks lists and notifications are added to alert staff when there is new information from health professionals. As part of the assessment, we analysed care visit data and found that care continuity has improved since the last inspection with fewer late care visits. The system for monitoring care visits is being used more fully to address trends and concerns. The office team has been restructured to assign responsibilities more effectively to staff who can ensure rotas and care visits provide continuity.

People and relatives told us they did not feel informed by the provider. One person told us, "A while ago they rang me and asked if anyone had rung me to ask about how things were going, they hadn’t, but I don’t get regular calls". One relative told us "My mum has two carers four times a day. They arrive together but there have been occasions that they haven’t, and no one has informed us that this was going to happen." If people spoke a language other than English the provider did not provide information in a format they could understand. One relative told us, "I give feedback on mums’ behalf as she does not speak English". Relatives did not know details of the organisation. One relative told us, "I have no idea what the office side of things is like"

The registered manager gave an example about how information is shared with people by care staff in a format suited to them, for example using a whiteboard to write on and share information. They also told us that people were supported to receive information via relatives if they did not have the capacity to understand themselves. The registered manager confirmed there is currently no regular outgoing communications sharing information with people who receive a service.

The provider did not send out information on a regular basis in the form of a newsletter for example. People and relatives were not informed of changes within the service and improvements being made. We saw communication needs within peoples care plans, for example requesting staff communicate in clear language at a slow pace for people with Dementia.

We did not look at Listening to and involving people during this assessment. The score for this quality statement is based on the previous rating for Responsive.

People and relatives felt they had equal access to the care provided. One relative told us, "Recently they have been sending carers that speak [relatives] languages”. People told us that when they have requested to keep certain carers because they have built a valuable relationship, this is supported. One person told us, "[Registered Manager] reassured me that I will have my usual carer back on Tuesday after he has had his days off.".

Staff told us that if they were delayed, they would make attempts to contact the office or the person they were due to support so that the person was aware or so that cover could be arranged. One staff member told us, "I call the manager to tell them, and they let the next client know." Another staff member told us, "I inform the office and explain why I am late, and they will inform the client. If the office line is busy, we call the clients ourselves." Staff told us how they would cater their care to ensure people had the same level of access to their services. One staff member told us, “If they cannot remember something it is good to sit and talk with them and gently and politely remind them”.

Quality assurance professionals had identified that care visit monitoring had improved and care records were more detailed to ensure people had equal access to care from carers. The service had not needed to be responsive to new demand since the last inspection. One professional reported that people were generally happy with the service and felt they receive care and support when they need it, wishing to remain with them in the longer term.

We found that the provider complies with legal equality and human rights requirements, including avoiding discrimination, considering the needs of people with different protected characteristics with appropriate policies in place. Initial assessments had not taken place since the last inspection, however a new format of assessment was seen which captured details of protected characteristics and whether people needed additional support to access the service. Care plans we saw consistently detailed peoples individual preferences and protected characteristics. Peoples communication needs were clearly detailed and care delivery was adapted to make care accessible to peoples needs such as one care plan stating carers were to use a whiteboard and pen for one person who could not communicate verbally.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.